Radiological and Clinical Outcomes comparing 2-level MIS Lateral and MIS Transforaminal Lumbar Interbody Fusion in Degenerative Lumbar Spinal Stenosis

Study design: Retrospective Cohort Study Objectives: To compare early postoperative radiological and clinical outcomes between 2-level minimally invasive (MIS) trans-psoas lateral lumbar interbody fusion (LLIF) and MIS transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spinal stenosis. Methods: Fifty three consecutive patients undergoing 2-level lumbar interbody fusion from L3-L5 for degenerative lumbar spinal stenosis were enrolled. Twenty four patients underwent LLIF and 29 underwent TLIF. Results: Operative time and length of stay were similar between LLIF and TLIF (272.8 +/- 82.4 vs 256.1 +/- 59.4 minutes; 5.5 +/- 2.8 vs 4.7 +/- 3.3 days, P > .05), whereas blood loss was lower for LLIF (229.0 +/- 125.6 vs 302.4 +/- 97.1mls, P = .026). Neurological deficits were more common in LLIF (9 vs 3, P = .025), whereas persistent deficits were rare for both (1 vs 1, P = 1). For both groups, all patient reported outcomes visual analogue scale (VAS back pain, VAS leg pain, ODI, SF-36 physical) improved from preoperative to 2-years postoperative (P < .05), with both groups showing no significant differences in extent of improvement for any outcome. Lateral lumbar interbody fusion demonstrated superior restoration of disc height (L3-L4: 4.1 +/- 2.4 vs 1.2 +/- 1.9 mm, P < .001; L4-L5: 4.6 +/- 2.4 vs .8 +/- 2.8 mm, P < .001), foraminal height (FH) (L3-L4: 3.5 +/- 3.6 vs 1.0 +/- 3.6 mm, P = .014; L4-L5: 3.0 +/- 3.5 vs -.1 +/- 4.4 mm, P = .0080), segmental lordosis (4.1 +/- 6.4 vs -2.1 +/- 8.1 degrees, P = .005), lumbar lordosis (LL) (4.1 +/- 7.0 vs -2.3 +/- 12.6 degrees, P = .026) and pelvic incidence-lumbar lordosis (PI-LL) mismatch (-4.1 +/- 7.0 vs 2.3 +/- 12.6 degrees, P = .019) at 2-years follow-up. Conclusion: The superior radiological outcomes demonstrated by 2-level trans-psoas LLIF did not translate into difference in clinical outcomes compared to 2-level TLIF at the 2-years follow-up, suggesting both approaches are reasonable for 2-level lumbar interbody fusion in degenerative lumbar spinal stenosis.

Automated summary

This retrospective cohort study compared the radiological and clinical outcomes of 2-level minimally invasive (MIS) trans-psoas lateral lumbar interbody fusion (LLIF) and MIS transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spinal stenosis. The study found that LLIF had superior radiological outcomes in terms of restoration of disc height, foraminal height, segmental lordosis, lumbar lordosis, and pelvic incidence-lumbar lordosis mismatch, but there were no significant differences in clinical outcomes compared to TLIF at the 2-year follow-up.